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Community-acquired pneumonia (CAP) continues to be a topic of great interest to physicians, but one that remains filled with controversy because of the limitations of current diagnostic testing and therapeutic options. Unfortunately, Brown and Lerner's letter serves only to emphasize the emotion and misunderstanding in this field. Their letter is unnecessarily critical and inaccurate and is typical of the controversy in this area. It certainly does not accurately reflect the content of our Update or the ATS guidelines on CAP [1].

Brown and Lerner ask how Bartlett and Mundy's review could be interpreted to mean that the ATS guidelines for CAP are appropriate. The Update clearly states that Bartlett and Mundy recommended routine diagnostic testing in CAP, a position that differs from the ATS guidelines. It then stated that on the basis of the pathogens causing CAP (and shown in Table 3 of the Update), the ATS guidelines were appropriate. In fact, the pathogens in the table were almost identical to the pathogens that were reported in the ATS guidelines to cause CAP in hospitalized patients. On the basis of these data, Bartlett and Mundy recommended empirical therapy (when necessary) for hospitalized patients that is identical to that recommended in the ATS guidelines [2]. This was the only point being made in the Update. However, in another paper not discussed in the Update, Bartlett and Mundy specifically stated that on the basis of the bacteriology of CAP seen in immunocompetent patients in their hospital, their findings “support the current American Thoracic Society guidelines for selective use of macrolide therapy” [3].